test 3
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| cleft lip/cleft palate | results from failure of soft or bony tissues of the upper jaw or palate to unite between 7-12 weeks gestation
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| possible causes for cleft lip/palate | family history, parental age, maternal drug exposure, alcohol/smoking, folic acid and vitamin deficiency
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| cleft lip surgical repair usually occurs | within first two months of life (cheiloplasty)
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| cleft palate repair usually occurs | after child is 10mos. to a year old (palateplasty)
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| nursing care for cleft lip/palate | inspect newborns palate, note ability to suck/swallow, assess caregiver response and bonding, assess resp. status, watch for aspiration, weight checks of infant
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| nursing diagnosis pre-op cleft lip/palate | R/F aspiration, altered nutrition: less, altered parenting
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| nursing diagnosis post-op cleft lip/palate | R/F injury, R/F infection, Pain, Knowledge deficit
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| Nursing care for child with cleft lip/palate | adequate nutrition and daily weights, feed upright, special feeding devices, burp every ounce eaten, assist with parental bonding
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| post-op cleft lip care | NPO starting fluids slowly, keep pain free, clean suture with saline, lie on back in carseat, may use elbow restraints
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| post op cleft palate care | same as cleft lip except: can place on abdomen (preferred), monitor packing if used, feed so that no solid object can enter the mouth, avoid straws/pacifiers/thumbsucking, observe operative site for infection
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| Gastroesophageal reflux (GER) | back flow of gastric contents into esophagus as a result of relaxation or incompetance of the cardiac sphincter
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| Cause of gasteraesophageal reflux | unknown but is most common in premature infants and those with neurological impairment
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| Signs and symptoms of GER | regurgitation and emesis immediately following a feeding. Emesis is considered non-billious but may contain undigested milk or mucous, esophogitis may also occor.
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| esohpogitis | causes excessive crying and irritability, refusal to feed,poor weight gain, hematemesis (blood in vomit), and melena (blood in stool, anemia, resp. signs including apnea, choking, gagging after feedings, and aspiration or pneumonia
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| Diagnosis of GER may include | careful history and growth pattern, upper GI, upper GI endoscopy, esophogeal pH probe study(catheter in nose 18-24 hours to monitor pH levels and # of reflux episodes.
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| Treatment of GER | small frequent meals and correct positioning- prone with head elevated or flat prone.
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| Medications for GER | antacids and prokinetics- propulsid and Reglan which increase gastric motility and enhance gastric emptying, and acid suppression meds- proton inhibitors like Prilosec, and histamine 2 receptor antagonists like Tagament and Zantac
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| surgery for GER | only in severe cases they perform a Nissen fundoplication where the fundus of the stomach is wrapped around the malfunctioning sphincter
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| Nursing diagnosis in relation to GER | R/F aspiration
altered nutrition: less than body requirements
knowledge deficit
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| Interventions for GER | teach milk thickening and nipple enlargement, keep suction bedside, small frequent feedings, burp frequently, feed solids followed by liquids,
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| Hypertrophic Pyloric Stenosis | pyloric sphincter gets larger or hypertraphies and increased its thickness by 4 times, narrowing the opening for food to pass to the duodenum
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| cause of HPS | unknown but heredity may play a role
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| S&S of HPS | doesn't show up until about 4-6 weeks, begin to vomit immediately after feeding, projectile vomiting as condition worsens, infant hungry and wants to feed despite feeding and vomiting, dehydration, lethargy, weight loss
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| diagnosis of HPS includes | palpation of an olive shaped mass in epigastrum(above and to right of umbilicus), visible peristalsis, UGI, ultrasound
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| treatment of HPS | pyloromyotomy- surgical split of the pylorus muscle which enlarges the opening
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| Nursing diagnosis in relation to HPS | fluid volume deficit, R/F aspiration, altered nutrition:less, knowledge deficit, post-op--R/F infection
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| Interventions for HPS | I $ O, daily weights, NPO before surgery, assess lab work for electrolytes, record stool characteristics, Post op--usually about 6 hrs after surgery if bowel sounds present, administer glucose water or electrolyte solution in small feedings
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| Hirschprung's disease (megacolon) | structural anomalie of the GI tract caused by lack of ganglionic cells in segments of the colon; lack of peristalsis causes blockages
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| S&S of megacolon | Newborn-no passage of meconium w/in 48 hrs.abd. distension.billious vomit. constipation w/ diarrhea
infant- failure to thrive plus above
child- visible peristalsis, ribbon feces, plus above
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| treatment of megacolon | step 1- involves temporary colostomy
step 2- child reaches 20 lbs. they perform an endorectal pull through.
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| interventions related to megacolon | restore nutritional status, low finer, high protein and high calorie, may give bowel meds such as stool softeners, measure abd. girth
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| Failure to Thrive | an abdominal retardation of growth and development of the infant, resulting from conditions that interfere with normal metabolism, appetite and activity
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| Causes of failure to thrive | organic- caused by physical problem
non-organic- caused by psychosocial factors (poverty, neglect, ineffective bonding, etc)
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| S&S of failure to thrive | height and weight somewhere between 5th and 8th percentile, listlessness, and lethargy, signs of neglect, scanty stool
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| treatment of failure to thrive | provide sufficient calaries and nutrition to "catch up" growth. educate parents and provide with support
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| Assessment of failure to thrive | subj-diet history, infant routines, support systems, any substance abuse, education, stress factors
obj.-height/weight, malnutrition, dev. milestone delay, parent/infant interaction
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| tracheosophageal fistula/esophageal atresia | malformations in which the esophagus fails to develop as a continuous passage (both are life threatening)
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| Atresia | incomplete formation of the esophagus, terminates before reaching the stomach
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| fistula | unnatural opening is formed between the esophagus and the trachea.
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| causes of atresia and fistula | usually associated with prematurity and also associated with polyhydramnios(excessive amniotic fluid), usually children also have other congenital defects.
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| S&S of fistula and atresia | constant drooling, cannot swallow, excessive mucous from mouth and sometimes the nose,abd. distention, unable to pass og tube, Hallmark sign when feeding is the three C's=coughing, chocking and cyanosis
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| treatment of fistula or atresia | must do surgergical repair depends on the abnormality, may require one or numerous surgeries, may need gastrosomy tube or IV until surgery is done
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| Nursing diagnosis related to fistula or atresia | R/F aspiration, ineffective airway clearance, R/F fluid volume deficit, anxiety
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| Interventions for fistula and atresia | post op--begin feeding 2-3 days post op through tube feedings, when ordered begin oral feedings starting with glucose water , keep on back with head elevated
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| Colic | intestinal cramping; usually between 1-2 weeks until about 6 weeks
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| Cause of colic | unknown--theories include gas in intestines, but not supported by research
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| S&S of colic | loud crying, flexing at hips, rule of three's(crying during first 3 months, lasting at least 3 hrs/day, occurs more than 3 days/wk., and continues at least 3 weeks)
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| Treatment of colic | feed slowly burp often, keep upright to feed, swaddle and hold close, take on a car ride, use swing, supply background noise, pacifier
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| interventions for colic | provide parents with support
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| hyperbilirubinemia | excessive amounts of bilirubin in the blodd
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| bilirubin is considered elevated if | above 12mg/dl
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| hyperbilirubinemia interventions | monitor for jaundice, examine skin under naturl light, provide early frequent feedings to pass meconium, prepare for phototherapy, inspect the stool, inspect skin out of UV light 4-6 hrs, reposition q 2hrs, provie stimulation
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| Biliary Atresia | congenital absence or obstruction of bile ducts outside of liver which prevents flow of bile from liver to intestines--most frequent reason for liver transplant in children
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| S&S of biliary atresia | jaundice appears, tea-colored urine, lt. colored stool, hepatomegaly, failure to thrive, malnutrition
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| surgery to correct obstruction and allow drainage of bile, surgery is not a cure and not all are successful, complications continue and end stage liver disease requires transplant | treatment of biliary atresia
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| celiac disease | inability to ingest and tolerate gluten(protein component of wheat, barley, rye, and oats)
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| S&S of celiac disease | anorexia, diarrhea with large amounts of fat, severe abd pain, delayed growth, muscle wasting, irritable/behavior changes, delayed tooth eruption
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| small bowel biopsy | definitive diagnosis of celiac disease
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| treatment of celiac disease | gluten free diet for rest of life. substituted with rice or corn, vitamin supplements, adequate fluids, monitor electrolytes/dehydration
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| toxic ingestion S&S | (dependent upon poison)resp. distress, severe nausea or vomiting, decreased level of conciousness, seizures, restlessness, color changes in skin, burns to mouth and edema in lips, odor to breath, urine color change, pupil change, shock and cardiac arrest
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| Interventions with toxic ingestion | first maintain airway, determine substance, call poison control
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